TY - JOUR
T1 - Exhaled CO 2 monitoring to guide non-invasive ventilation at birth
T2 - A systematic review
AU - Monnelly, Vix
AU - Josephsen, Justin B.
AU - Isayama, Tetsuya
AU - De Almeida, Maria Fernanda B.
AU - Guinsburg, Ruth
AU - Schmölzer, Georg M.
AU - Rabi, Yacov
AU - Wyckoff, Myra H.
AU - Weiner, Gary
AU - Liley, Helen G.
AU - Solevåg, Anne Lee
N1 - Publisher Copyright:
© 2024 BMJ Publishing Group. All rights reserved.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Objective Measuring exhaled carbon dioxide (ECO 2) during non-invasive ventilation at birth may provide information about lung aeration. However, the International Liaison Committee on Resuscitation (ILCOR) only recommends ECO 2 detection for confirming endotracheal tube placement. ILCOR has therefore prioritised a research question that needs to be urgently evaluated: € In newborn infants receiving intermittent positive pressure ventilation by any non-invasive interface at birth, does the use of an ECO 2 monitor in addition to clinical assessment, pulse oximetry and/or ECG, compared with clinical assessment, pulse oximetry and/or ECG only, decrease endotracheal intubation in the delivery room, improve response to resuscitation, improve survival or reduce morbidity?'. Design Systematic review of randomised and non-randomised studies identified by Ovid MEDLINE, Embase and Cochrane CENTRAL search until 1 August 2022. Setting Delivery room. Patients Newborn infants receiving non-invasive ventilation at birth. Intervention ECO 2 measurement plus routine assessment compared with routine assessment alone. Main outcome measures Endotracheal intubation in the delivery room, response to resuscitation, survival and morbidity. Results Among 2370 articles, 23 were included; however, none had a relevant control group. Although studies indicated that the absence of ECO 2 may signify airway obstruction and ECO 2 detection may precede a heart rate increase in adequately ventilated infants, they did not directly address the research question. Conclusions Evidence to support the use of an ECO 2 monitor to guide non-invasive positive pressure ventilation at birth is lacking. More research on the effectiveness of ECO 2 measurement in addition to routine assessment during non-invasive ventilation of newborn infants at birth is needed. PROSPERO registration number CRD42022344849.
AB - Objective Measuring exhaled carbon dioxide (ECO 2) during non-invasive ventilation at birth may provide information about lung aeration. However, the International Liaison Committee on Resuscitation (ILCOR) only recommends ECO 2 detection for confirming endotracheal tube placement. ILCOR has therefore prioritised a research question that needs to be urgently evaluated: € In newborn infants receiving intermittent positive pressure ventilation by any non-invasive interface at birth, does the use of an ECO 2 monitor in addition to clinical assessment, pulse oximetry and/or ECG, compared with clinical assessment, pulse oximetry and/or ECG only, decrease endotracheal intubation in the delivery room, improve response to resuscitation, improve survival or reduce morbidity?'. Design Systematic review of randomised and non-randomised studies identified by Ovid MEDLINE, Embase and Cochrane CENTRAL search until 1 August 2022. Setting Delivery room. Patients Newborn infants receiving non-invasive ventilation at birth. Intervention ECO 2 measurement plus routine assessment compared with routine assessment alone. Main outcome measures Endotracheal intubation in the delivery room, response to resuscitation, survival and morbidity. Results Among 2370 articles, 23 were included; however, none had a relevant control group. Although studies indicated that the absence of ECO 2 may signify airway obstruction and ECO 2 detection may precede a heart rate increase in adequately ventilated infants, they did not directly address the research question. Conclusions Evidence to support the use of an ECO 2 monitor to guide non-invasive positive pressure ventilation at birth is lacking. More research on the effectiveness of ECO 2 measurement in addition to routine assessment during non-invasive ventilation of newborn infants at birth is needed. PROSPERO registration number CRD42022344849.
KW - neonatology
KW - resuscitation
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U2 - 10.1136/archdischild-2023-325698
DO - 10.1136/archdischild-2023-325698
M3 - Article
C2 - 37558397
AN - SCOPUS:85168280865
SN - 1359-2998
VL - 109
SP - 74
EP - 80
JO - Archives of Disease in Childhood: Fetal and Neonatal Edition
JF - Archives of Disease in Childhood: Fetal and Neonatal Edition
IS - 1
ER -